Perspective on HIV Self-testing in North America: A Tale of Two Countries—US and Canada

Abstract

Long waiting time in clinics, loss of working days to obtain an HIV test result, fear of social visibility, perceived stigma, and discrimination, associated with facility-based HIV testing impede testing efforts. Not surprisingly, therefore, about 25% of Canadians and Americans with HIV continue to live unaware of their positive sero-status, and knowingly or unknowingly contribute to continued HIV transmission in their communities. To such individuals, self-testing for HIV, offers one potential, proactive, de-stigmatizing screening solution. Individuals can screen themselves in the comfort of their home or assisted by a health care professional, and combine it with remote on phone or in person expedited counseling. Self testing has the potential for expanded access, and offers a confidential private testing option, but high costs of currently approved self test, concerns about timely linkages to counseling and care, coupled with a lack of awareness and knowledge about self tests, in communities that desire it the most, stand as obstacles to its expansion. Will self-testing strategy, achieve its destiny of reaching the untested and of expanding access in a people-friendly convenient and affordable manner? Will it succeed in linking people to counseling and care in a timely manner? And, lastly, Will it also bring many more partners to self-test? In this perspective, we explore some of these questions, discusses potential ways in which self testing for HIV could be offered, accessed, expanded, operationalized within Canada and US, to help reach many more individuals that desire a self testing solution.